Sow the wind
Dec 4th 2008
From The Economist print edition
The long-lasting consequences of a health scare
FLEDGLING engineers learn about disasters like the 1988 Piper Alpha oil-rig fire or the explosion of the space shuttle Challenger in 1986 as a reminder of the dangers that attend their profession. Perhaps, if the subject ever achieves respectability, media-studies undergraduates will pore over the measles, mumps and rubella (MMR) vaccine scare in 21st-century Britain.
On November 28th the Health Protection Agency (HPA), which monitors infectious diseases, said that there were 1,049 cases of measles in England and Wales in the ten months to October 2008. Even before the year is out, that makes 2008 the worst year since 1995, when current reporting methods began (see chart). The rise, says the HPA, is due to a fall in vaccination rates. In 1998 91% of two-year-olds were immunised, but by 2004 that had fallen to 80%, far below the 90% rate needed to keep the disease under control.
Reluctance to vaccinate stems from a health scare surrounding MMR, a three-in-one vaccine designed to protect children from measles, mumps and rubella. In 1998 Andrew Wakefield, then a lecturer at London?s Royal Free Hospital, suggested that MMR could cause autism and opined that single-use vaccines should be used instead (although the paper he based his recommendations on asserted no such link).
Three years later, Dr Wakefield published another paper and the scare got into its stride. A breathless media blew his findings out of all proportion, making the idea of a link between MMR and autism into a huge story. Tony Blair, then prime minister, assured the public that MMR was safe but refused to say whether his own son had been vaccinated. Reassurances from doctors and ministers were widely disbelieved by a public which remembered soothing noises about BSE that were later proved wrong. A string of subsequent studies (and a meta-study of 31 other papers) found nothing to suggest that MMR has anything to do with autism. But it was too late: by then many parents, egged on by anti-vaccination campaigners, were refusing to give MMR to their children.
Epidemiologists at the HPA worry that the cohort of unvaccinated children may lead to a big outbreak, with between 30,000 and 100,000 people falling ill. That would mean a number of deaths: the fatality rate for measles in rich countries is one in somewhere between 2,500 and 5,000. Something similar has already happened with mumps: 55,000 people fell ill between 2004 and 2006 (death from mumps is exceptionally rare).
Happily, the dip in vaccination seems to have been temporary. Immunisation rates today are 85% and rising, and the government is running a catch-up programme for those who missed their jabs the first time round. Lessons have been learnt, too: Tammy Boyce, a research fellow at the King?s Fund, a health think-tank, says that professional bodies such as the Royal College of Paediatrics and the Royal Society now try harder to dampen scares early.
But she lays much of the responsibility for the MMR furore at the door of a scientifically illiterate, scaremongering press. And whereas health officials may have learnt from their experiences, she is less sure about the fourth estate. ?Have the media learnt anything?? she wonders. ?No, on balance, I don?t think they have.? With some of the campaigners that opposed MMR now questioning the safety of a vaccine designed to protect teenagers against the human papilloma virus, a common sexually-transmitted infection, that is a depressing conclusion.